Transcatheter edge-to-edge mitral valve repair (M-TEER) is an increasingly common non-surgical treatment for severe mitral regurgitation (MR). Achieving optimal leaflet capture and minimizing MR typically requires multiple grasping attempts during the procedure, but whether repeated maneuvers affect procedural safety has remained unclear.
A consecutive series of 391 patients with severe MR who underwent M-TEER with the PASCAL system between 2019 and 2024 was analyzed (mean age 77.7 years, 57.5% male). Patients were stratified by number of grasping attempts: ≤7 (median 4) versus ≥8 (median 10, maximum 22). No single leaflet device attachment, leaflet injury, or other device-related complication occurred in either group.
Procedures with ≥8 attempts took longer (126 vs. 83 minutes) and involved more challenging anatomy, reflected in a larger baseline effective regurgitant orifice area (EROA). Despite this, improvement in MR severity from baseline to discharge, durability of MR reduction at latest follow-up, NYHA functional class improvement, and all-cause mortality (7.3% vs. 6.5%) were comparable between groups.
The findings suggest that multiple leaflet-grasping attempts during PASCAL-based M-TEER are safe, achieving sustained MR reduction and clinical outcomes similar to procedures requiring fewer attempts — supporting a patient, persistent approach in cases with more complex anatomy.
Source: Safety of multiple grasping attempts during transcatheter mitral valve repair with the PASCAL system, International Journal of Cardiology, 2026.